Fusarium soloni mycetoma

A young apparently healthy, non-diabetic, HIV non-reactive woman presented with a mycetoma-like lesion on right buttock. Discharge was scanty, and mycotic grains were not seen. Biopsy of sinus track was obtained for microscopy and culture. Microscopic examination revealed plenty of fungal hyphae in direct microscopic examination of grounded tissues in saline; KOH, Gram's, and H and E-stained smears. All the three inoculated slants of Sabouraud's media yielded heavy growth of Fusarium solani. Presence of numerous hyphal fragments in direct microscopy and heavy growth of F. solani in all three slants indicative of etiological role of fungus in the present case. It is probably a first report of F. soloni mycetoma from India.     

Mycetoma with black granules: first case in a native of Israel]

We present a case of black grain mycetoma caused by Madurella mycetomatis. The diagnosis was made on the basis of conventional light microscopy and mycological studies. After 12 months of oral therapy with ketoconazole, the patient showed partial response. This is the first native Israeli case of black grain mycetoma.     

色素性基底细胞癌

报告1例色素性基底细胞癌。患者女,68岁。右侧腋下黑色条状斑块10余年。皮肤科检查:右侧腋下约3.0 cm×0.2 cm大黑色斑块,边界尚清,其上散在分布数个米粒大黑色丘疹,斑块中部可见糜烂、渗液,渗液周边可见炎症性红斑,无触痛。皮损组织病理检查:表皮层局灶瘤细胞巢,表皮至真皮层可见一肿块,由嗜碱性基底样细胞组成,可见细胞异形性及有丝分裂象,在肿块周边细胞呈栅栏状排列,可见收缩间隙。诊断:色素性基底细胞癌。     

Mycetomas in central Tunisia

INTRODUCTION: Mycetomas are inflammatory pseudo-tumors containing fungal or actinomycosic-type grains. They are frequent in tropical and subtropical countries and unknown in Tunisia. PATIENTS AND METHODS: We conducted a retrospective study of 12 cases of mycetoma registered in the Dermatological department of the university hospital in Sousse (central Tunisia) over a period of 27 years, from 1974 to 2001. The diagnosis was confirmed by anatomopathological and/or mycological examination. RESULTS: The mean age at the onset was of 49 years and the sex ratio of 1. A notion of a traumatism was reported in two cases and eight patients had various agricultural activities. The mean duration of progression was of eight years. The localization was the foot in 10 cases. The mycetoma was of actinomycosic origin in 10 cases, due to Actinomadura madurae in nine cases, to Nocardia spp in one case and of fungal origin in 2 cases:Pseudoallescheria boydii in one case and Madurella mycetomi in the other. Antibiotic therapy was associated with surgical exeresis in nine cases and amputation in the other two cases. COMMENTS: Confrontation of our results with those of Tunisian series and a review of the literature, helped to specify the clinico-epidemiological characteristics and progression of mycetoma in Tunisia. These characteristics are: the rareness of the infection, the relative frequency of affection in women, the proximal involvement of the foot, the frequency of agricultural activity and the rareness of traumatic past history, the predominance of the actinomycosic origin due to Actinomadura madurae, and the need to associate surgical exeresis with the medical treatment or amputation in order to stop the progress of the disease.     

Mycetoma: retrospective study of 13 cases in Tunisia

Mycetomas are inflammatory pseudotumors of chronic and progressive evolution, of fungal (Eumycetoma), or bacterial (Actinomycetoma) origin. We conducted a retrospective study of patients who have been consulted for mycetoma over a period of 28 years. Thirteen cases of mycetomas were collected during the 28-year period, 10 patients were of rural origin. The lesions were localized on the foot in all instances. There was no male predominance. Histopathological examination confirmed mycetoma in all 13 cases and the determination of the infectious agent in 9 cases: 4 actinomycotic and 5 fungal. Microbiological examination identified the species in 7 cases. Bone involvement was found in 10 cases. Eumycetomas were treated by ketoconazole. The other cases were treated as actinomycetomas by antibiotics. The antibiotic treatment was associated with surgical excision in 4 cases and with amputation in 1 case. Mycetomas are rare in Tunisia, and only observed sporadically, for this reason the diagnosis is usually late, with severe functional, psychological, and socioeconomic consequences.     

Koebner phenomenon on skin graft donor site in cutaneous angiosarcoma.

An 81-year-old woman developed a necrotic plaque and a surrounding purple-red, irregularly shaped macule on her scalp. The diagnosis of angiosarcoma was confirmed histologically. A wide surgical excision was made followed by a split-thickness skin graft from her right buttock. Nine months later, she noticed a dark purple-red lesion on the donor site which grew rapidly into a large mass. Histological examination revealed irregular clefts and vascular channels lined by atypical endothelial cells. Lung metastasis and pneumothorax were also noted. The secondary tumor appeared to represent Koebner phenomenon in a patient with angiosarcoma of the scalp.     

Deep fungal and higher bacterial skin infections in Thailand: clinical manifestations and treatment regimens

BACKGROUND: Deep fungal and higher bacterial skin infections occur fairly frequently in Thailand. METHODS: Cases with a provisional diagnosis of deep fungal and higher bacterial infections were prospectively collected from 1994 to 1997 in the Granuloma Clinic, Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. Demographic data, clinical manifestations, causative organisms, histologic features, treatment, and outcome were investigated. RESULTS: The total cases in a 4-year period numbered 27. The male to female ratio was approximately 1:1. Mycetoma was most common, followed by chromoblastomycosis. Actinomycetoma was similar in incidence to eumycetoma. The only causative organism that could be identified among the mycetoma cases was Cladosporium carrionii, which caused mycetoma of the buttock of an aplastic anemia patient at the site of bone marrow aspiration. Surgical treatment was recommended for eumycetoma. Chromoblastomycosis was caused by C. carrionii and F. compactum and responded well with itraconazole orally. Mycotic abscesses were found in four cases, basidiobolomycosis in two cases, and cutaneous nocardiosis in one case. Cotrimoxazole was recommended in the treatment of actinomycetoma, cutaneous nocardiosis, and basidiobolomycosis. CONCLUSIONS: Localized, chronic, slow, progressive, and usually asymptomatic were the main cutaneous manifestations of deep fungal and higher bacterial skin infections. A skin biopsy for histologic study and culture identification should be performed in every suspected case. The causative organisms were found in the histologic sections of every case, but only about one-third were found by culture.     

注射维生素K1致湿疹型皮肤反应一例

[摘要] 目的 报告肌注维生素K1致湿疹型皮肤反应1例。方法 对患者的临床资料进行分析,且对本病进行了文献回顾。结果 患者女,10岁。发现右臀部一椭圆形红斑1月。起皮疹前1周曾肌注维生素K1。皮肤科情况：右侧臀部外上方可见一6cm×5cm大小、椭圆形红色斑块,其中央有一片状、密集排列、粟粒大小的水疱,局部皮温略高,质硬,有浸润感。诊断：注射维生素K1致湿疹型皮肤反应。确诊后予盐酸非索非那定片口服和他克莫司软膏外用,治疗26天后皮疹基本消退。结论 肌注维生素K1致湿疹型皮肤反应临床罕见,有特征性,应被皮肤科医生所重视。     

Mycetoma: infection with tumefaction, draining sinuses, and "grains".

Mycetoma is a tumorous infection of skin and subcutaneous tissue. It is caused by either actinomycotic bacteria or eumycotic fungi. The three cardinal features are tumefaction or the appearance of indolent inflammatory nodules and secondary fibrosis, formation of sinus tracts and fistulas that may have the ability to penetrate deep tissue, and the presence of grains or granules in the affected tissue and discharge. Although mycetoma is relatively uncommon in the United States, increasing mobility and changes in demographic characteristics should lead to a greater awareness of this disease. Characteristic histopathologic findings and microbiological identification establish the diagnosis. Consequently, when evaluating what might seem like an ordinary skin or fungal infection, we must widen our differential diagnosis to include mycetoma. Effective treatments for actinomycetoma are available, whereas eumycetoma is often difficult to treat.     

足底基底细胞癌1例

报告1例足底基底细胞癌.患者男,70岁,右足底皮肤黑色斑片2年.皮肤专科检查:右足底见一 2 cm×3 cm大小的黑色斑片,边界尚清,皮损表面可见一表浅性溃疡,病灶无红肿、渗液,无流血、流脓,无触痛及压痛.皮肤镜检查可见黄白色结构伴少许蓝灰色结构,见个别不典型溃疡伴少许点状血管.皮损组织病理检查可见真皮浅层的基底样细胞...     

Mycetoma: Nonvenereal perineal lesions

Mycetoma is a chronic, granulomatous disease of the skin, and subcutaneous tissue, which sometimes involves muscle, bones, and neighboring organs. It is characterized by tumefaction, abscess formation, and fistulae with discharge of grains from sinuses. Mycetoma can be caused by various species of fungi (eumycetoma) and aerobic actinomycetes (actinomycetoma), which occur as saprophytes in soil or plants. A tentative diagnosis sufficient to initiate treatment may be made on the basis of grain color. For instance, melanoid grains are always caused by fungi and ochroid or pale grains by actinomycetes. Although this is not the thumbrule, there are exceptional reports too. As trauma favors infection, most lesions are on the foot and lower leg but they may occur anywhere on the body mimicking actinomycosis. However, lab investigations and culture are important tool to differentiate apart from the clinical picture. We are reporting atypical case with unusual site of presentation (perineum and thigh) of mycetoma.     

河南不规则毛霉致原发性皮肤毛霉病一例

【摘要】 患者女,50岁。右上肢皮肤结节、斑块、红肿、溃烂6年,右臀部斑块2年,右面颊斑块1年。曾单独口服特比萘芬、伊曲康唑治疗无效。右上肢及臀部皮损组织病理及PAS染色均可见真皮内宽大呈直角分支菌丝。真菌培养及分子生物学鉴定为不规则毛霉。联合伊曲康唑和特比萘芬治疗2个月仍无效,改为静脉滴注两性霉素B（总量1 060 mg）治疗,患者右面颊、右臀部斑块肿胀逐渐消退,右上肢包括右手背斑块、红肿、坏死、黑痂消退,皮损愈合成瘢痕,取右上肢皮肤组织再次行真菌培养阴性。随访1年未复发。     

Pseudallescheria boydii Mycetoma in Northern New England

Mycetoma is a chronic subcutaneous fungal infection characterized by tumefaction, draining sinuses, and grains. It is most common in the tropics but occasionally occurs in the United States. We report a case of a mycetoma affecting the foot of a 38-year-old mentally retarded man from northern New England. The causal organism was identified as Pseudallescheria boydii, the most common cause of mycetoma in the United States. The patient showed a partial response to 8 months of ketoconazole therapy.     

Actinomycetoma of the chest wall attributed to Nocardia nova after reconstructive surgery

A 29-year-old man, presented with multiple ulcers, nodules, abscesses, fistulae, and atrophic scars, over the right chest wall. Six years prior, the patient had a car accident, which resulted in skin loss of the right arm, shoulder, thoracic wall. In addition, he suffered a supracondylar fracture; orthopedic surgery and skin grafts were required. Material discharging from sinus tracts was obtained for mycological and bacteriological studies. Direct microscopic examination revealed small white grains. Cultures on Sabouraud and Lowenstein-Jensen media isolated orange-white colonies suggestive of Nocardia. PCR assay identified Nocardia nova. Thoracic and right upper limb CT showed signs of chronic osteomyelitis. Treatment with imipenem/cilastatin for 8 weeks, followed by amoxicillin clavulanate for 6 months, resulted in healing of lesions and improvement in the patient's general health. Primary cutaneous nocardiosis remains a diagnostic challenge. Nocardia are soil-borne filamentous gram-positive bacteria. Identification of characteristic granules on examination of discharge smears from discharge or tissue biopsy is essential for diagnosing mycetoma. Because grain discharge is discontinuous, multiple clinical specimens should be submitted for microscopic examination and culture. Sulfonamides have been the mainstay of Nocardia actinomycetoma treatment. However, our patient's strain was resistant to Co-trimoxazole. Therefore, treatment with imipenem followed by amoxicillin clavulanate was favored, with good clinical and analytical response.     

Eumycetoma due to Madurella mycetomatis acquired in Jamaica

We report a case of eumycetoma due to Madurella mycetomatis affecting the left dorsal forefoot in a 35-year-old woman. She had spent her childhood in Jamaica, and had been resident in the U.K. for 20 years prior to her presentation. She gave a highly suggestive history for a mycetoma, having observed the intermittent discharge of black grains from the lesion. The diagnosis was confirmed by histological and mycological analysis of the grains, and a magnetic resonance imaging scan excluded osteomyelitis. She has responded very favourably to treatment with itraconazole. Mycetomas due to M. mycetomatis have not previously been reported from Jamaica.     

Botryomycosis. A bacterial cause of mycetoma.

Botryomycosis is a chronic, granulomatous, bacterial infection in which grains are produced. Clinically, it may not be distinguished from a mycetoma of fungal origin. A case is reported in which the causative organisms were Staphylococcus aureus and Pseudomonas aeruginosa.     

Isolation of both Pseudozyma aphidis and Nocardia otitidiscaviarum from a mycetoma on the leg

We describe a case of mycetoma which typified the classic presentation of the disease: a male farmer with affection of the lower limbs and a history of trauma. The patient presented with a swollen right lower limb showing multiple discharging sinuses for 25 years. Histopathologically, grains were found by HE stain, and clustered yeast-like cells were observed by PAS stain. The distinctive 'dot-in-circle' sign was found through MRI. Besides Nocardia otitidiscaviarum, Pseudozyma aphidis was isolated from deep tissue culture, and the identification of the etiologic species was ascertained by DNA sequencing. Generally speaking, Nocardia otitidiscaviarum is an infrequent cause of mycetoma, and Pseudozyma species are usually isolated from plant material rather than clinical specimens. This is the first case of mycetoma from which both Nocardia otitidiscaviarum and Pseudozyma aphidis were isolated.     

Malignant melanoma of the buttock presenting as a Buruli ulcer

We report an unusual case of malignant melanoma clinically diagnosed as Buruli ulcer, that arose in a 13-year-old boy and presented as an ulcerated, fungating 2 cm mass on the right buttock. The tumor showed the histology and immunohistology of a malignant melanoma. We present this interesting case of malignant melanoma of soft tissue, arising in an unusual location of the body. The tumor presented with clinical features of Buruli ulcer in an area endemic for this disease as well as other tropical ulcerations. Neoplasms, including melanoma, should be considered in the differential diagnosis of Buruli ulcer in endemic areas.     

Epidermodysplasia verruciformis associated with isolated IgM deficiency

A 20 year-old man presented to our clinic with multiple warts on both hands and tumoral lesions on his face but otherwise healthy. On dermatological examination, numerous brown-black papular lesions, changing from 2 to 5 cm in diameter were found on his face along with multiple, flesh-coloured, flat-topped papules on the dorsa of his hands. A tumoral lesion, approximately 3 cm in diameter on the right side of his forehead and desquamated erythematous macules were also observed on the trunk. Laboratory investigations showed that serum immunoglobulin M (IgM) level was decreased. The histopathological examination of verrucous lesions on the hands was consistent with epidermodysplasia verruciformis and the histopathological diagnosis of the tumoral lesion was squamous cell carcinoma.     

Black grain mycetoma

In a study of the black tissue grains formed in mycetoma caused by Madurella mycetomi, the evidence pointed to a tanned protein or melanoprotein as the main durable constituent of the grain cement. It appeared likely that the melanizing agent arose from the fungus, while the protein component came from the host. Resistance to treatment was considered to depend on the impenetrability of the cement so produced.